Truman Medical Centers Lakewood Community Health Needs Assessment June 2016
Table of Contents Table of Contents 2 Introduction 3 Overview, Process and Priorities 4 Service Area 6 Demographics, Socioeconomics & Vulnerable Populations 10 Access to Care 22 Chronic Disease 28 Maternal & Infant Health 32 Behavioral/Mental Health 36 Senior Services 39 Strategic Plan 40 Partners & Organization Leadership 42 Alignment to Other Community Plans 45 References 46 Survey Instruments & Results 47 Truman Medical Centers Lakewood 2016 Community Health Needs Assessment Page 2
Introduction Truman Medical Center (TMC) Lakewood is a full-service medical campus featuring a spacious, community hospital and long-term care center. Located in the rolling hills of Eastern Jackson County, MO., TMC Lakewood offers patients state-of-the-art medical services in a special healing environment. The hospital is part of Truman Medical Centers, a two-hospital, 600-bed, not-for-profit healthcare system, the largest and most comprehensive safety net healthcare system in Jackson County and Kansas City, Missouri. In addition, TMC is an academic medical center, the primary teaching facility for the University of Missouri Kansas City. Close to 30% of physicians who practice in the Kansas City region completed training at TMC. Recognized as a critical area resource for advanced specialized healthcare, TMC is constantly working to deliver the best possible medical care for our patients. Quality, innovation, teamwork and attention to detail are at the heart of all we do. TMC s tagline is: Better. For Everyone. It is a simple statement, but it has profound significance. It is what we stand for, it is the focus of our work, and it is our promise to our patients. Truman Medical Centers is one of America s Essential Hospitals. This unique network of hospitals and health systems is recognized for its dedication to high-quality care for all, including the most vulnerable. In this role, TMC is a primary provider of essential community services that touch all people, including trauma and burn care, disaster response, public health, preventive services, and medical education. Further, as an Essential Hospital, TMC has a duty to assure health equity; meaning there is a focus on continuous improvement in reducing disparities by providing care that is equitable and culturally competent. TMC leadership is focused on improving population health, and to achieve that goal the focus is on understanding barriers to care and addressing them in ways that meet patient need. Mission: Truman Medical Centers is an academic health center providing accessible, state-ofthe-art quality healthcare to our community regardless of the ability to pay. Vision: Leading the way to a healthy community. Truman Medical Centers Lakewood 2016 Community Health Needs Assessment Page 3
Overview Process & Priorities Assessing the needs of the community is an integral part of TMC s day-to-day operations. As a safety net provider with a significant population of uninsured patients, it is critical to TMC s survival to assure provision of care that meets community need and keeps the costs of care as reasonable as possible. A formal community health needs assessment process was initiated in the fall of 2012, and again in the fall of 2015. This process included the following steps: Define Community. As part of this phase, TMC examined the current patient data file and other documentation of defined geographic service area for Hospital Hill and Lakewood facilities. This included: Define geographic service area Define specific target populations with broader reach than the geographic service area Identify Partners. TMC has many partners. As part of its ongoing work in meeting community need, TMC engages these organizations in strategic planning and in helping identify organizational priorities. During this phase, TMC completed the following: Established an inventory of TMC involvement in community-based partnerships Identified consumers and engaged them through focus groups and surveys Secondary Data: TMC assembled a broad set of data to measure and evaluate health status, health statistics and the incidence rates of disease, illness and accidents using secondary data sources. This phase of the assessment focused on not only on health outcomes, but also on factors that influence future health, such as health and wellness habits, experiences accessing care and attitudes that influence healthy behavior. Primary Data. This effort to measure and evaluate health status, health statistics and the incidence rates of disease, illness and accidents used Truman Medical Centers data. The primary data collection effort focused on health outcomes and factors that influence health, such as homelessness, insurance coverage and health care system utilization for specific conditions; specific to the TMC patient experience. Aggregated Data. TMC assimilated Secondary and Primary data sets into a combined comprehensive report and overview of the TMC service areas and patients. The aggregated data report is reflected throughout this report. Identify & Prioritize Issues. This phase engaged the board, organizational leadership, key constituents and community partners to identify and prioritize community health issues; using the results of the data analysis. Multiple surveys were utilized during this process, with delineation of responses between TMC staff/leadership and the community overall. Truman Medical Centers Lakewood 2016 Community Health Needs Assessment Page 4
Develop & Implement Strategies. This process is ongoing at TMC, and includes engaging the board, organizational leadership, key constituents and community partners to identify the strategic direction for the organization and results in a set of strategies to address prioritized community health issues. This process, which extends well beyond the community health needs assessment, includes: Developing strategies in collaboration with intersectional partners to solve existing community health problems. Identifying and building upon community assets and direct them toward resolving health problems. Leading efforts in the community to link individuals with preventive, health promotion and other health services. Developing plans to address key issues not currently being addressed. As with the 2012 CHNA, a survey was prepared and distributed to Truman Medical Centers community partners and separately to TMC staff. As part of the survey process, respondents were asked to select issues, and also to consider services that they believe could be strengthened relative to availability, access or quality. These results are being used to inform decision-making relative to these issues. Responses linked to the final priorities included in this report are reflected with the respective issues. After analysis of responses, the following issues emerged: Access to Primary Care Providers Chronic Disease Maternal & Infant Health Behavioral Health Senior Health Services Truman Medical Centers Lakewood 2016 Community Health Needs Assessment Page 5
Service Area The TMC Lakewood geographic service area includes 60 zip codes in its primary service area. This primary service area is home to 779,958 people (ACS 2010-2014). The service area comprises the urban core of Kansas City, along with the suburban and rural communities that surround the Kansas City metro area. Truman Medical Centers Lakewood 2016 Community Health Needs Assessment Page 6
As a regional health care system, TMC Lakewood services a much larger geographic region, as reflected in the map below. Truman Medical Centers Lakewood 2016 Community Health Needs Assessment Page 7
TMC Lakewood s primary service area is also home to three Federally Qualified Health Centers, Kansas City CARE Clinic, Swope Health Services, and Samuel U Rodgers Health Center. Truman Medical Centers Lakewood 2016 Community Health Needs Assessment Page 8
Metro Kansas City has multiple hospitals, as reflected below. Truman Medical Centers Lakewood 2016 Community Health Needs Assessment Page 9
Demographic and Socioeconomic Overview The TMC Lakewood service area is home to 779,958 people. Jackson County, Missouri has 604.46 square miles in land area and a population density of 1,121.94 persons per square mile. The population is 8.56% Hispanic (of any race). The population in Jackson County is growing at a slower rate than in Missouri and the U.S., with an increase of 2.94% between the 2000 and 2010 census. Missouri grew by 7.04% and the U.S. by 9.71%. This slow growth rate is reflective of an overall trend of people moving away from the urban core and into surrounding suburban and rural areas. (ACS 2010 Census) Total Population 779,958 Total Area in Square Miles 640.46 Persons Per Square Miles 1,121.94 Total Population by Gender Gender Total Percent Male 377,711 48.4% Female 402,247 51.6% Total Population by Age Age Groups Total Percent Age 0 to 17 187,304 24.0% Age 18-64 490,439 62.9% Age 65 and up 102,215 13.1% Total Population by Race/Ethnicity. The racial composition of TMC s Lakewood service area includes two primary categories: White and African American. These two categories comprise 90.51% of the customers within the Lakewood area. Racially, the TMC Lakewood service area reflects the greater Jackson County, Missouri racial mix, with 68.9% White, 21.61% African American, 1.9% Asian, 0.47% Native American/Alaskan Native, 0.24% Native Hawaiian/Pacific Islander, 3.68% reporting some other race, and 3.2% reporting multiple races. TMC Service TMC Service Missouri Race/Ethnicity Area Total Area Percent Percent White 537,394 68.9% 82.81% Black 168,550 21.61% 11.54% Asian 14,856 1.9% 1.69% Native American/Alaska Native 3,658 0.47% 0.49% Native Hawaiian/Pacific Islander 1,880 0.24% 0.1% Some Other Race 28,651 3.68% 1.06% Multiple Race 24,969 3.2% 2.39% Truman Medical Centers Lakewood 2016 Community Health Needs Assessment Page 10
Hispanic 66,736 8.56% 3.76% Socio-economic data reflect the TMC Lakewood service area has a large number of people in poverty status. The median family income in Jackson County is slightly higher than the state levels, but lower than U.S. levels. However, the zip-code service area served by TMC Hospital Hill has significantly lower income levels. The TMC Lakewood service area has a higher rate of individuals living below 200% of the Federal Poverty Level (FPL) when compared to Jackson County, Missouri and the United States overall. In the report area 36.4% or 279,469 individuals are living in households with income below 200% of the Federal Poverty Level (FPL), as compared to the state level of 35.47% and the national level of 34.54%. As noted with the median family income and education levels, TMC Lakewood s zip-code service area has significantly higher FPL rates than most of the county. It is even more compelling to note that 25.86% or 41,645 children aged 0-17 in Jackson County are living in households with income below the Federal Poverty Level (FPL). The rates are even higher for the zip-code areas served by TMC Lakewood. Truman Medical Centers Lakewood 2016 Community Health Needs Assessment Page 11
The same pattern holds true for education levels. For the Jackson County area, 11.5% of county residents have no more than a high school education. When looking at zip-code level data however, the areas served by TMC Lakewood have higher rates of those with less than a high school education. Of the 522,921 people age 25 and over in the TMC Lakewood service area, 40.7% do not have any education beyond high school. Only 27.8% of this population has a Bachelor s degree or higher education. TMC Lakewood Educational Attainment of Population Age 25 and Older 3.2% Less than 9th Grade High School Diploma or GED Associate's Degree Master's or Professional Degre 7.9% A lack of access to care 1 presents barriers to good health. The supply and accessibility of facilities and physicians, the rate of uninsurance, financial hardship, transportation barriers, cultural competency, and coverage limitations affect access. Lack of insurance often plays a significant role in an individual s decision-making regarding whether or not to seek primary and preventive health care services. Lack of coverage also typically means that people have limited choices in terms of where they may seek care. A higher rate of Jackson County, Missouri residents lack health insurance when compared to Missouri and the U.S. overall. 29.6% 24.3% Percent Uninsured Population 9th to 12th Grade Some College, No Degree Bachelor's Degree 7.1% 17.6% 10.2% Jackson County, MO (15.59%) Missouri (12.88%) United States (14.2%) Vulnerable Populations are those regions where there are a high rate of individuals living at or below 100% Federal Poverty Level and where 25% or more of the area population have less Truman Medical Centers Lakewood 2016 Community Health Needs Assessment Page 12
than a high school education. The map below providers a geographic overview of zip codes within the TMC Lakewood primary service area that meet this threshold. Truman Medical Centers Lakewood 2016 Community Health Needs Assessment Page 13
Racial & Ethnic Data Overview Truman Medical Centers Lakewood 2016 Community Health Needs Assessment Page 14
Truman Medical Centers Lakewood 2016 Community Health Needs Assessment Page 15
Special Populations TMC Lakewood serves a number of special populations in addition to the general population of the service area. These populations tend to be low income, high risk patients with care needs that exceed those of the general population. As part of the Community Health Needs Assessment, populations of specific focus include those with dual eligibility and individuals who are homeless. Dual Eligibles According to the Kaiser Family Foundation, about 9 million people in the United States are covered by both Medicare and Medicaid, including low-income seniors and younger people with disabilities. These dual eligible beneficiaries have complex and often costly health care needs, and have been the focus of many recent initiatives and proposals to improve the coordination of their care aimed at both raising the quality of their care while reducing its costs. Dual eligibles are much poorer and have greater health needs than other Medicare beneficiaries. More than half have annual incomes of less than $10,000, while only 8 percent of all other Medicare beneficiaries are as poor. Dual eligibles are also more likely to be disabled; live in an institution, such as a nursing home; and report poor health status. Dual eligibles are considerably more likely than other Medicare beneficiaries to suffer from chronic health conditions, such as diabetes, chronic lung disease, and Alzheimer s disease. i TMC s recognition as a high quality safety net health care system brings a significant number of dually eligible patients through its doors. The ability to draw on the newest innovations and emerging practices in medicine as a result of its affiliation with the University of Missouri Kansas City medical school makes TMC the provider of choice for this vulnerable population. In fiscal year 2015 (July 1, 2014 June 30, 2015), Lakewood provided services to 3,228 dual eligible patients through 14,442 visits (an average of 4.5 visits per patient during the year). Visits are inclusive of both outpatient and inpatient care. The average patient age was 59 years, with ages ranging from 0 to 105 years. 65.3% of dual eligible patients were females. The maps that follow reflect the geographic reach and scope of this population. Truman Medical Centers Lakewood 2016 Community Health Needs Assessment Page 16
This map provides an overview of the number of dual-eligible patients living in the primary service who received services at TMC Lakewood during FY 2015. Truman Medical Centers Lakewood 2016 Community Health Needs Assessment Page 17
This map provides an overview of the number of visits made by dual-eligible patients living in primary service area who received services at TMC Lakewood during FY 2015. Truman Medical Centers Lakewood 2016 Community Health Needs Assessment Page 18
Patients who are homeless According to the National Health Care for the Homeless Council: Living on the street or in crowded homeless shelters is personally stressful and made worse by being exposed to communicable disease (e.g. TB, respiratory illnesses, etc.), violence, malnutrition, and harmful weather exposure. ii,iii,iv Hence, common conditions such as high blood pressure, diabetes, and asthma become worse because there is no safe place to store medications or syringes properly. Maintaining a healthy diet is difficult in soup kitchens and shelters as the meals are usually high in salt, sugars, and starch (making for cheap, filling meals but lacking nutritional content). v Behavioral health issues such as depression or alcoholism often develop or are made worse in such difficult situations, especially if there is no solution in sight. vi Injuries that result from violence or accidents do not heal properly because bathing, keeping bandages clean, and getting proper rest and recuperation isn t possible on the street or in shelters. Minor issues such as cuts or common colds easily develop into large problems such as infections or pneumonia. i,iii In fiscal year 2015 (July 1, 2014 June 30, 2015), Lakewood provided services to 92 homeless patients through 158 visits (an average of 1.7 visits per patient during the year). Visits are inclusive of both outpatient and inpatient care. The average patient age was 43 years, with ages ranging from 18 to 87 years of age. 83.6% of homeless patients were males. While Lakewood sees significantly fewer homeless patients than are seen at Hospital Hill, this population is of specific concern to both facilities due to their vulnerability. The maps that follow reflect the density of Lakewood s homeless patients. Truman Medical Centers Lakewood 2016 Community Health Needs Assessment Page 19
This map reflects the number of homeless patients who accessed services at TMC Lakewood during fiscal year 2015. Truman Medical Centers Lakewood 2016 Community Health Needs Assessment Page 20
This map reflects the number of visits to TMC Lakewood made by homeless patients during fiscal year 2015. Truman Medical Centers Lakewood 2016 Community Health Needs Assessment Page 21
Access to Care Lack of a Consistent Source of Primary Care This indicator reports the percentage of adults aged 18 and older who self-report that they do not have at least one person who they think of as their personal doctor or health care provider. This indicator is relevant because access to regular primary care is important to preventing major health issues and emergency department visits. Slightly over 20% of adults age 18 and over in Jackson County self-report that they do not have at least one person who they think of as their personal doctor or health care provider. Report Area Survey Population (Adults Age 18+) Total Adults Without A Regular Doctor Percent Adults Without A Regular Doctor Jackson County 456,513 94,063 20.60% Missouri 4,560,355 938,202 20.57% United States 236,884,668 52,290,932 22.07% Percent Adults Without Any Regular Doctor Jackson County, MO (20.60%) Missouri (20.57%) United States (22.07%) Emergency Department Utilization Utilization of the hospital emergency department for non-emergency conditions is an indicator of low access to primary care. This access can be impacted by multiple factors; low income, education level, lack of insurance, and employment that places limits on a persons ability to have time off of work to see a health care provider. Truman Medical Centers Lakewood 2016 Community Health Needs Assessment Page 22
Emergency Department visits are categorized using the Canadian Triage and Acuity Scale (CTAS) The CTAS levels are designed such that level 1 represents the sickest patients and level 5 represents the least ill group of patients. Explanation and examples of cases which would fall under each category are listed below. Level 1 Resuscitation Conditions that are threats to life or limb (or imminent risk of deterioration) requiring immediate aggressive interventions. Examples of types of conditions that would be Level 1are: Cardiac/Respiratory arrest, major trauma, shock states, unconscious patients, severe respiratory distress. Level 2 Emergent Conditions that are a potential threat to life limb or function, requiring rapid medical intervention or delegated acts. Examples of types of conditions which would be Level 2 are altered mental states, head injury, severe trauma, neonates, MI, overdose and CVA. Level 3 Urgent Conditions that could potentially progress to a serious problem requiring emergency intervention. May be associated with significant discomfort or affecting ability to function at work or activities of daily living. Examples of types of conditions which would be Level 3 are moderate trauma, asthma, GI bleed, vaginal bleeding and pregnancy, acute psychosis and/or suicidal thoughts and acute pain. Level 4 - Less Urgent (Semi urgent) Conditions that are related to patient age, distress, or potential for deterioration or complications would benefit from intervention or reassurance within 1-2 hours. Examples of conditions which would be Level 4 are headache, corneal foreign body and chronic back pain. Level 5 - Non Urgent Conditions that may be acute but non-urgent as well as conditions which may be part of a chronic problem with or without evidence of deterioration. The investigation or interventions for some of these illnesses or injuries could be delayed or even referred to other areas of the hospital or health care system. Examples of types of conditions which would be Level 5 are sore throat, URI, mild abdominal pain which is chronic or recurring, with normal vital signs, vomiting alone and diarrhea alone. In calendar year 2015, the Lakewood Emergency Department had 18,824 patients who made 30,004 visits. These visits fell into the CTAS as follows: Level 1 Level 2 Level 3 Level 4 Level 5 0% 4.3% 51.4% 34.8% 3.5% Truman Medical Centers Lakewood 2016 Community Health Needs Assessment Page 23
Lack of Prenatal Care This indicator reports the percentage of women who do not obtain prenatal care during their first trimester of pregnancy. This indicator is relevant because engaging in prenatal care decreases the likelihood of maternal and infant health risks. This indicator can also highlight a lack of access to preventive care, a lack of health knowledge, insufficient provider outreach, and/or social barriers preventing utilization of services. Report Area Total Births Mothers Starting Prenatal Care in First Semester Mothers with Late or No Prenatal Care Prenatal Care Not Reported Percentage Mothers with Late or No Prenatal Care Jackson County 41,317 6,149 3,217 31,951 7.79% Missouri 318,557 56,322 16,666 245,569 5.2% United States 16,693,978 7,349,554 2,880,098 6,464,326 17.3% Dental Care TMC provides safety net dental services to medically underserved children and adults in Eastern Jackson County, Missouri. Medicaid is a primary payment source for TMC dental patients. Missouri Department of Health and Senior Services data show that 135,608 people in Jackson County were enrolled in Medicaid as of February 2016, including 79,398 children age 17 and under. A lack of dental providers that will accept Medicaid patients ensures that TMC serves patients far beyond its primary service area. There were 7,750 Emergency Department visits related to disorders of the teeth and jaw in Jackson County in 2013, for a rate of 11.6 per 1,000. Dental Related Emergency Room Visits Jackson County 2009 2010 2011 2012 2013 7,263 7,549 7,533 7,365 7,750 A significant number of patients receive dental services through the Lakewood dental clinic. Maps on the following 2 pages provide a geographic overview of patients and visits to TMC dental providers during fiscal year 2015. Truman Medical Centers Lakewood 2016 Community Health Needs Assessment Page 24
This map reflects the number and percentage of individuals who access dental services from TMC during Fiscal Year 2015 Truman Medical Centers Lakewood 2016 Community Health Needs Assessment Page 25
TMC s dental program has a significant geographic reach, as reflected in this regional map. Truman Medical Centers Lakewood 2016 Community Health Needs Assessment Page 26
TMC s Focus for CHNA Impact Access is an overarching theme in TMC s CHNA. As an Essential Hospital, TMC is the safety net health system for the greater Kansas City region. In this capacity, TMC has a continual focus on assuring access; access to outpatient clinical care, access to specific target populations, and access to services needed by the community at large. With the community continuing to experience a shortage of primary care providers, TMC remains committed to working with the three Federally Qualified Health Centers to assure access to specialty care. Through a variety of mechanisms, TMC will continue its efforts to increase access to all types of care, for all community members. Using a health equity approach, which recognizes the impact of socio-ecological factors on a persons ability to access health care, TMC continues to identify locations for direct outreach, including community-based clinics and community-based health education. This approach is an underlying theme to everything TMC undertakes; with staff members educated in cultural competence and trauma-informed care. This approach was designed to create an atmosphere of welcome for all who interact with TMC. Because of this focus, TMC will continue its goal of being the provider of choice for key health conditions which include Sickle Cell disease, HIV and other chronic conditions that disproportionately impact minority populations in the greater Kansas City region. Truman Medical Centers Lakewood 2016 Community Health Needs Assessment Page 27
Chronic Disease Chronic diseases are responsible for 7 of 10 deaths each year, and treating people with chronic diseases accounts for 86% of our nation s health care costs according to the CDC. Chronic diseases are non-communicable illnesses that are prolonged induration, do not resolve spontaneously, and are rarely cured completely. Chronic diseases include heart disease, cancer, stroke, diabetes, and arthritis. Impact in the TMC Service Area Health Issue Jackson County Missouri U.S. Diabetes Prevalence 10% 9.62% 9.11% Obesity Prevalence 30.1% 30.3% 27.1% Asthma Prevalence 16% 14.2% 13.4% Percent Population Smoking Cigarettes 22.2% 23.2% 18.1% (Age-Adjusted) Heart Disease Mortality (per 100,000) Healthy People 174.3 198.5 175 2020 Target: <100.8 Cancer Mortality (per 100,000) Healthy People 2020 188.9 182.4 168.9 Target: <160.6 Stroke Mortality (per 100,000) Healthy People 2020 Target: <33.8 43 43 37.9 Asthma Prevalence Asthma is a chronic disease that affects the airways in the lungs. During an asthma attack, airways become inflamed, making it hard to breathe. Asthma attacks can be mild, moderate, or serious and even life threatening. Asthma costs the United States $56 billion each year. In the last decade, the proportion of people with asthma in the United States grew by nearly 15%, according to the CDC. This indicator reports the percentage of adults aged 18 and older who self-report that they have ever been told by a doctor, nurse, or other health professional that they had asthma. This indicator is relevant because asthma is a prevalent problem in the U.S. that is often exacerbated by poor environmental conditions. Asthma Related Emergency Room Visits Jackson County 2009 2010 2011 2012 2013 5,023 5,382 5,362 6,346 5,579 Truman Medical Centers Lakewood 2016 Community Health Needs Assessment Page 28
Tobacco Usage (Adult) In the Jackson County area an estimated 110,552, or 21.9% of adults age 18 or older self-report currently smoking cigarettes some days or every day. This indicator is relevant because tobacco use is linked to leading causes of death such as cancer and cardiovascular disease. Diabetes Prevalence (Adult) Diabetes can cause serious health complications including heart disease, blindness, kidney failure, and lower-extremity amputations. Diabetes is the seventh leading cause of death in the United States, according to the CDC. This indicator reports the percentage of adults aged 20 and older who have ever been told by a doctor that they have diabetes. This indicator is relevant because diabetes is a prevalent problem in the U.S.; it may indicate an unhealthy lifestyle and puts individuals at risk for further health issues. Diabetes Related Emergency Room Visits Jackson County 2009 2010 2011 2012 2013 1,715 2,064 1,968 2,080 1,924 Obesity (Adult) The estimated annual medical cost of obesity in the U.S. was $147 billion in 2008 U.S. dollars; the medical costs for people who are obese were $1,429 higher than those of normal weight, according to the CDC. This indicator reports the percentage of adults aged 18 and older who self-report that they have a Body Mass Index (BMI) greater than 30.0 (obese). Excess weight may indicate an unhealthy lifestyle and puts individuals at risk for further health issues. Report Area Total Population Age 20+ Adults with BMI > 30.0 (Obese) Percent Adults with BMI > 30.0 (Obese) Jackson County, MO 498,155 151,439 30.1% Missouri 4,456,386 1,365,174 30.3% United States 231,417,834 63,336,403 27.1% Fast Food Restaurants This indicator reports the number of fast food restaurants per 100,000 population. Fast food restaurants are defined as limited-service establishments primarily engaged in providing food services (except snack and nonalcoholic beverage bars) where patrons generally order or select items and pay before eating. This indicator is relevant because it provides a measure of healthy food access and environmental influences on dietary behaviors. Truman Medical Centers Lakewood 2016 Community Health Needs Assessment Page 29
Fast Food Restaurants, Rate (Per 100,000 Population) Jackson County, MO (75.06) Missouri (68.5) United States (72.7) Grocery Store Access This indicator reports the number of grocery stores per 100,000 population. Grocery stores are defined as supermarkets and smaller grocery stores primarily engaged in retailing a general line of food, such as canned and frozen foods; fresh fruits and vegetables; and fresh and prepared meats, fish, and poultry. Included are delicatessen-type establishments. Convenience stores and large general merchandise stores that also retail food, such as supercenters and warehouse club stores are excluded. This indicator is relevant because it provides a measure of healthy food access and environmental influences on dietary behaviors. Grocery Stores, Rate (Per 100,000 Population) Jackson County, MO (15.87) Missouri (18.2) United States (21.2) Physical Inactivity (Adult) Within the report area, 121,500 or 24% of adults aged 20 and older self-report no leisure time for activity, based on the question: "During the past month, other than your regular job, did you participate in any physical activities or exercises such as running, calisthenics, golf, gardening, or walking for exercise?". This indicator is relevant because current behaviors are determinants of future health and this indicator may illustrate a cause of significant health issues, such as obesity and poor cardiovascular health. Percent Population with no Leisure Time Physical Activity Truman Medical Centers Lakewood 2016 Community Health Needs Assessment Page 30
Jackson County, MO (24%) Missouri (25.5%) United States (22.6%) Fruit and Vegetable Consumption In the report area an estimated 413,806, or 80% of adults over the age of 18 are consuming less than 5 servings of fruits and vegetables each day. This indicator is relevant because current behaviors are determinants of future health, and because unhealthy eating habits may cause of significant health issues, such as obesity and diabetes. Percent Adults with Inadequate Fruit / Vegetable Consumption Jackson County, MO (80%) Missouri (79.1%) United States (75.7%) TMC s Focus for CHNA Impact Because chronic diseases impact a significant number of TMC s patients, and their prevalence in the community is high, the focus in this area is on continuous improvement of programs and services across all initiatives. Community need, and patient demand, will continue to be monitored with services tailored to meet need. Chronic disease self-management programs will be delivered in neighborhood settings to encourage participation, and patients with significant, and co-occurring conditions will be encouraged to enroll in specialty programs for assistance with medication management, self-care and other supportive services. Truman Medical Centers Lakewood 2016 Community Health Needs Assessment Page 31
Maternal and Infant Health According to the CDC, pregnancy and childbirth have a huge impact on the physical, mental, emotional, and socioeconomic health of women and their families. Pregnancy-related health outcomes are influenced by a woman's health and other factors like race, ethnicity, age, and income. Lack of Prenatal Care Prenatal care can help keep expectant mothers and babies healthy. Babies of mothers who do not get prenatal care are three times more likely to have a low birth weight and five times more likely to die than those born to mothers who do get care, according to the Office of Women s Health. This indicator reports the percentage of women who do not obtain prenatal care during their first trimester of pregnancy. This indicator is relevant because engaging in prenatal care decreases the likelihood of maternal and infant health risks. This indicator can also highlight a lack of access to preventive care, a lack of health knowledge, insufficient provider outreach, and/or social barriers preventing utilization of services. Percentage Mothers with Late or No Prenatal Care Jackson County, MO (7.79%) Missouri (5.2%) United States (17.3%) Births Nearly half of all births in Jackson County are covered by Medicaid. 2014 Jackson County Births by Payor Medicaid Non-Medicaid Unknown Total 4,242 5,147 131 9,520 Teen Pregnancy Teen pregnancy and childbearing bring substantial social and economic costs through immediate and long-term impacts on teen parents and their children according to the CDC. Truman Medical Centers Lakewood 2016 Community Health Needs Assessment Page 32
In 2010, teen pregnancy and childbirth accounted for at least $9.4 billion in costs to U.S. taxpayers for increased health care and foster care, increased incarceration rates among children of teen parents, and lost tax revenue because of lower educational attainment and income among teen mothers. Pregnancy and birth are significant contributors to high school dropout rates among girls. Only about 50% of teen mothers receive a high school diploma by 22 years of age, whereas approximately 90% of women who do not give birth during adolescence graduate from high school. The children of teenage mothers are more likely to have lower school achievement and to drop out of high school, have more health problems, be incarcerated at some time during adolescence, give birth as a teenager, and face unemployment as a young adult. This indicator reports the rate of total births to women age of 15-19 per 1,000 female population age 15-19. This indicator is relevant because in many cases, teen parents have unique social, economic, and health support services. Additionally, high rates of teen pregnancy may indicate the prevalence of unsafe sex practices. Teen Birth Rate (Per 1,000 Population) Jackson County, MO (52.2) Missouri (39.5) United States (36.6) The birth rate among teens ranges widely when reviewing the data by Race/Ethnicity. While the teen birth rate is higher in Jackson County than in Missouri and the U.S., it is significantly higher among Hispanic teens. Births to Women Age 15-19, Rate (per 1,000 Pop.) by Race / Ethnicity 100 50 0 Non-Hispanic White Non-Hispanic Black Hispanic or Latino Jackson County, MO Missouri United States Truman Medical Centers Lakewood 2016 Community Health Needs Assessment Page 33
Infant Mortality This indicator reports the rate of deaths to infants less than one year of age per 1,000 births. This indicator is relevant because high rates of infant mortality indicate the existence of broader issues pertaining to access to care and maternal and child health. Low Birth Weight This indicator reports the percentage of total births that are low birth weight (Under 2500g). This indicator is relevant because low birth weight infants are at high risk for health problems. This indicator can also highlight the existence of health disparities. Area Infant Mortality (per 1,000) Percent Low Birth Weight Jackson County 8.2 8.4% Missouri 7.2 8% U.S. 6.5 8.2% Healthy People 2020 Target <=6.0 N/A TMC s Focus for CHNA Impact TMC s primary focus relative to the CHNA is to expand its community outreach and education efforts to bring more pregnant women into care earlier in their pregnancies. Furthering this approach, efforts under the Access area will place clinical points of care in neighborhoods throughout the service area offering more immediate access to providers. Truman Medical Centers Lakewood 2016 Community Health Needs Assessment Page 34
Behavioral Health According to the CDC, Mental disorders are common in the United States. In the U.S., about one in four adults and one in five children have diagnosable mental disorders (National Institute of Mental Health). Mental disorders are the leading cause of disability among ages 15-44 in the United States and Canada combined (National Institute of Mental Health). The cost of lost earnings alone due to major mental disorders in the United States is around $193 billion each year (Kessler et al., 2008). Suicide Suicide is a major public health concern. Over 41,000 people die by suicide each year in the United States; it is the 10 th leading cause of death overall according to the Center for Disease Control. Suicide is tragic. But it is often preventable. Knowing the risk factors for suicide and who is at risk can help reduce the suicide rate. Suicide does not discriminate. People of all genders, ages, and ethnicities can be at risk for suicide. But people most at risk tend to share certain characteristics. The main risk factors for suicide are: Depression, other mental disorders, or substance abuse disorder A prior suicide attempt Family history of a mental disorder or substance abuse Family history of suicide Family violence, including physical or sexual abuse Having guns or other firearms in the home Incarceration, being in prison or jail Being exposed to others' suicidal behavior, such as that of family members, peers, or media figures. This indicator reports the rate of death due to intentional self-harm (suicide) per 100,000 population. Figures are reported as crude rates, and as rates age-adjusted to year 2000 standard. Rates are summarized for report areas from county level data, only where data is available. This indicator is relevant because suicide is an indicator of poor mental health. Truman Medical Centers Lakewood 2016 Community Health Needs Assessment Page 35
Suicide, Age-Adjusted Death Rate (Per 100,000 Pop.) Jackson County, MO (15.9) Missouri (14.8) United States (12.3) Students (6th-12th grade) in Jackson County were asked about their mental health. 13.3% had considered suicide in the last year, 9.6% made a plan, and 2.4% actually attempted, resulting in an injury. In 2014, 104 Jackson County residents committed suicide, according to the Missouri Department of Health and Senior Services. Nationally, males are about four times more likely to commit suicide than females. Older males have higher rates of suicide than younger males. Behavioral Health Disorders Individual struggling with serious mental illness are at higher risk for homicide, suicide, and accidents as well as chronic conditions including cardiovascular and respiratory diseases and substance abuse disorders. In state fiscal year 2014, 12,448 Jackson County residents received treatment for serious mental illness at publicly-funded facilities. Of those, the majority were treated for mood disorders (7,051) and anxiety disorders (4,150). While there is data on those who receive treatment, data on mental health in the general population is very limited, especially at the local level. In Western Missouri, 18.2% of those 18 and older had a mental illness in the past year with 4.3% having a serious mental illness. Serious mental illness is defined as any of the mental disorders asked about and 'these disorders resulted in substantial impairment in carrying out major life activities'. Approximately 6.8% of Western Missouri residents ages 18+ had at least one major depressive episode in the past year. A major depressive episode is characterized by an extended period of depressed mood, loss of interest or pleasure, and impaired functioning. Typically, females are more likely to report having had a major depressive episode. Truman Medical Centers Lakewood 2016 Community Health Needs Assessment Page 36
Jackson County Selected Mental Health Disorders Diagnosis Trends 9000 8000 7000 6000 5000 4000 3000 2000 1000 0 FY 2009 FY 2010 FY 2011 FY 2012 FY 2013 FY 2014 Anxiety Disorders Mood Disorders Impulse Control Disorders Psychotic Disorders Alcohol and Substance Abuse Substance use disorder changes normal desires and priorities. It changes normal behaviors and interferes with the ability to work, go to school, and to have good relationships with friends and family. In 2014, 20.2 million adults in the U.S. had a substance use disorder and 7.9 million had both a substance use disorder and another mental illness according to the National Institute of Mental Health. The availability of county-level data on substance use and abuse is limited. The Missouri Student Survey can provide estimates for youth in most Missouri counties. This survey is administered in even-numbered years to 6th through 12th grade students in participating school districts. Youth who use alcohol are at greater risk of developing abuse problems later in life. An estimated 48.3% of youth in Jackson County believe that it would be easy to get alcohol, 21.5% think that their friends believe it is at least pretty cool to drink and 40.8% have friends who drink alcohol. The data for 2013, shown below, indicate the number of alcohol and substance related visits to the emergency room. It s interesting to note that alcohol abuse increases through age 64, while substance abuse peaks in the age 25-44 group and then decreases. Truman Medical Centers Lakewood 2016 Community Health Needs Assessment Page 37
Alcohol/Substance Related Emergency Room Visits, Jackson County, 2013 Total All Age 0-14 Age 15-24 Age 25-44 Age 45-64 Age 65+ Ages Alcohol-related 9 240 1567 2056 129 4001 mental disorders Substance-related 20 373 1051 316 28 1788 mental disorders Total 29 613 2618 2372 157 5789 Rates Per 1,000; Age Adjustment Uses 2000 Standard Population Alcohol and substance abuse related emergency room visits have been increasing over the past five years in Jackson County. ALCOHOL AND SUBSTANCE RELATED ER VISITS Alcohol-related mental disorders Substance-related mental disorders 4,500 4,000 3,500 3,000 2,500 2,000 1,500 1,000 500 0 2009 2010 2011 2012 2013 TMC s Focus for CHNA Impact The opioid crisis has become predominant in the community. TMC will model integrated primary care and intensive mental health/substance abuse services, including development of a clinic designed specifically to assist patients with medication-assisted therapy to address their addiction. As part of this model, TMC will continue to work with the local law enforcement community on Crisis Intervention training and Trauma-Informed Care approaches to assure individuals in crisis are effectively directed to care. Truman Medical Centers Lakewood 2016 Community Health Needs Assessment Page 38
Senior Services Emergency Department visits for mental health issues are significant among individuals age 65 and older, as evidenced in the table below: Emergency Room: Residents of Jackson County Age of Patient: = 65 and over Diagnosis: Mental disorders Year 2009 2010 2011 2012 2013 Total for Pay Source Number Rate Number Rate Number Rate Number Rate Number Rate Number Rate Medicare 514 6.2 523 6.2 569 6.7 543 6.2 560 6.2 2,709 6.3 Medicaid 21 0.3 23 0.3 26 0.3 26 0.3 41 0.5 137 0.3 Other Government 0 0.0 @ 1 0.0 @ 1 0.0 @ 3 0.0 @ 0 0.0 @ 5 0.0 @ Workers Comp 0 0.0 @ 3 0.0 @ 3 0.0 @ 0 0.0 @ 0 0.0 @ 6 0.0 @ Selfpay/No Charge 20 0.2 33 0.4 46 0.5 57 0.6 36 0.4 192 0.4 Commercial 63 0.8 63 0.8 41 0.5 60 0.7 59 0.7 286 0.7 Other 0 0.0 @ 4 0.0 @ 2 0.0 @ 0 0.0 @ 1 0.0 @ 7 0.0 @ Unknown 0 0.0 @ 0 0.0 @ 0 0.0 @ 0 0.0 @ 1 0.0 @ 1 0.0 @ All Pay Sources 618 7.4 650 7.7 688 8.1 689 7.9 698 7.7 3,343 7.8 Rates Per 1,000 Crude Rate @ Rate considered unstable, numerator less than 20 Many of these patients end up transferred to Lakewood s geri-psych program when they become too difficult for the nursing home to handle. As a result, this program is typically at capacity. In Fiscal Year 2015, the program had 383 unique inpatients, with a total of 432 admissions. With a capacity of 16 acute care beds for this patient population, it is evident that the need is extensive. TMC s Focus for CHNA Impact In response to community need, Lakewood offers a 188-bed fully accredited long-term care center, which includes an Alzheimer s and Dementia Unit and an award-winning intergenerational program. In addition, a 16 bed Geriatric Psychiatric Acute Care Unit is located adjacent to the Lakewood Care Center. This model assures our seniors a safe, patient-centered place to achieve stability and the hope of returning to a home-based environment for the long term. Geri-Psych services will continue to be a key focus at Lakewood. The goal is to return the patient back to the nursing home from which they were transferred. Decreasing transfers between facilities significantly reduces risk, and improves quality of life for seniors experiencing difficulty with cognitive function. Truman Medical Centers Lakewood 2016 Community Health Needs Assessment Page 39
TMC Strategic Plan Truman Medical Centers has a unique position. As both an academic medical center AND a safety net health system, TMC brings high need/high risk patients into a teaching/learning Quality Reputation & Improved Patient Outcomes Truman Medical Centers Lakewood 2016 Community Health Needs Assessment Page 40
environment. The synthesis is a reputation of high quality health care, improved health outcomes, and cost efficiency. This model creates significant value for ALL patients. Safety Net Academic Medical Center Truman Medical Centers Lakewood 2016 Community Health Needs Assessment Page 41
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Partners REACH Foundation Regional Health Care Initiative Safety Net Collaborative Regional Health Care Initiative Behavioral Health Healthcare Foundation of Greater Kansas City Kansas City Police Department Samuel U. Rodgers Health Center Swope Health Services University of Missouri Kansas City Midwest Cancer Alliance U.S. Bank Family Support Division Maternal Child Health Coalition WIC Healthy Start Children s Mercy Fetal Health Center Ryan White Grant Program Independence School District Mabee Foundation JE Dunn Construction Lakewood Anesthesia Alliant Techsystems, Inc Home State Health Plan United Way of Greater Kansas City (Outpatient clinics to the uninsured) R.A. Bloch Cancer Foundation (Cancer Center) Hall Family Foundation (NanoKnife) Truman Medical Centers Lakewood 2016 Community Health Needs Assessment Page 43
Truman Medical Centers Leadership Board of Directors (* indicates Board Officer) Dave Barber Forestine Beasley Paul M. Black* Sarah R. Chavez Rita M. Cortes* James Corwin Michelle desilva Peggy J. Dunn* Mike Enos Paul P. Holewinski Jolie L. Justus Steven Kanter, M.D. Stella Le Doux Peter S. Levi Tracey Lewis Marvin Lyman Angela Malone Maria Martinez Leo Morton Dennis S. O'Leary, M.D. Juan M. Rangel, Jr. Esmat Sadeddin, M.D. Philip J. Sanders* Dred D. Scott* Kara L. Settles, M.D. Mahnaz Shabbir Charles W. Shields Mark T. Steele, M.D. David W. Thompson* Eric D. Williams Timothy A. Wurst Karen Zecy* Truman Medical Centers Lakewood 2016 Community Health Needs Assessment Page 44
Leadership Team Charlie Shields President and Chief Executive Officer Mark Steele, MD Chief Medical and Operating Officer Lynette Wheeler, DNP, RN Chief Operating Officer Lakewood Mitzi Cardenas Sr. Vice President, Strategy, Business Development and Technology Bill Colby Chief Counsel Al Johnson Chief Financial Officer Niki Donawa Chief Community Relations Officer Ruth Pullins Chief Human Resources Officer Barb Zubeck Director of Audit and Compliance Gerard Grimaldi Vice President, Government Relations and Health Policy Karlyn Wilkins TMC Charitable Foundation, Executive Director Nancy Lewis, Vice President, Marketing and Public Relations Truman Medical Centers Lakewood 2016 Community Health Needs Assessment Page 45
Alignment to Other Community Assessment Plans Truman Medical Centers participates in the Kansas City Health Department s Community Health Assessment process. In 2015, KCHD began the process of updating the previous assessment and improvement plan, which covered 2011 to 2016. Reflecting back to this assessment, TMC s priorities have clear alignment with the Health Department priorities. From increasing access to clinical preventive services, illness care and public health services and interventions, to encouraging active living and healthy eating, TMC is committed to improving the health of its community. In the 2011-2016 Community Health Improvement Plan (CHIP) the Kansas City Health Commission identified six strategic issues: 1) Ensuring access to clinical preventive services, illness care, and public health services and interventions 2) Health equity and social determinants of health 3) Ensuring a safe and healthy community environment 4) Ensuring every child has a healthy start 5) Encouraging active living and healthy eating 6) Tobacco free living TMC provides paths to impact these issues through direct patient care, as well as through engagement in community-wide health improvement efforts that include expanding access to health care services through new primary care access points, and delivery of neighborhood based programs such as mobile care, healthy foods and chronic disease self-management classes. Moving forward, TMC remains an active community partner and stakeholder in Kansas City s Community Health Improvement planning process and in the implementation of the recently approved 2016-2021 CHIP for building a Culture of Health and a Healthier Kansas City. Truman Medical Centers Lakewood 2016 Community Health Needs Assessment Page 46
References U.S. Census Bureau, 2010-2014 American Community Survey 5-Year Estimates Community Health Needs Assessment Report (www.chna.org) UDS Mapper (www.udsmapper.org) Centers for Disease Control and Prevention, National Vital Statistics Systems Centers for Disease Control and Prevention, National Center for Health Statistics, Underlying Cause of Death MO Department of Health and Senior Services, MICA MO State Highway Patrol, UCR Query, Domestic Violence Reports MO Juvenile Court Annual Reports MO Department of Mental Health; Behavioral Health Epidemiology Workgroup; Community Behavioral Health Profiles MO Department of Social Services, Children s Services Division, Missouri Child Abuse/Neglect Annual Reports Truman Medical Center Electronic Medical Records Truman Medical Centers Lakewood 2016 Community Health Needs Assessment Page 47
Survey Instruments and Results Lakewood Staff Survey and Results Truman Medical Centers Lakewood 2016 Community Health Needs Assessment Page 48
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Community Survey & Results Truman Medical Centers Lakewood 2016 Community Health Needs Assessment Page 51
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